Case Report: Human metapneumovirus infection leading to septic shock in an adult with COPD and morbid obesity

Sep 28, 2026

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Case report of a 58-year-old man with morbid obesity and COPD who developed acute respiratory failure progressing to viral septic shock. Molecular testing of bronchoalveolar lavage using BioFire FilmArray identified human metapneumovirus type 1 as the sole pathogen. He required invasive mechanical ventilation, vasopressors, and continuous renal replacement therapy; vancomycin was stopped due to suspected nephrotoxicity and systemic corticosteroids were started. Later, bronchoalveolar lavage cultures revealed Streptococcus pneumoniae as bacterial superinfection. With supportive care, he improved, was extubated on day 9, and was discharged in stable condition.

LanguageEnglish

CategoryHealthcare

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Pages4

Reading Time10 min

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Background

Case

Case presentation

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OPEN ACCESS EDITED BY Francesca Collino, Città della Salute e della Scienza Hospital, Italy REVIEWED BY Meghana Nadiger, University of Texas Southwestern Medical Center, United States Harsahaj Singh Wilkhoo, Tbilisi State Medical University, Georgia *CORRESPONDENCE Giuseppe Accurso [giuseppe.accurso@policlinico.pa.it](giuseppe.accurso@policlinico.pa.it) †These authors have contributed equally to this work RECEIVED 29 October 2025 REVISED 17 November 2025 ACCEPTED 24 November 2025 PUBLISHED 18 December 2025 CITATION Virzì F, Giacopelli G, Tutone P, Riccobono C, Profera L, Raineri SM, Tomasello S and Accurso G (2025) Case Report: Human metapneumovirus infection leading to septic shock in an adult with COPD and morbid obesity. Front. Med. 12:1735031 . doi: 10.3389/fmed.2025.1735031 COPYRIGHT © 2025 Virzì, Giacopelli, Tutone, Riccobono, Profera, Raineri, Tomasello and Accurso. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. TYPE Case Report PUBLISHED 18 December 2025 DOI 10.3389/fmed.2025.1735031 Case Report: Human metapneumovirus infection leading to septic shock in an adult with COPD and morbid obesity Francesco Virzì 1†, Giuseppe Giacopelli 1†, Paolo Tutone 1, Cecilia Riccobono 1, Luigi Profera 2, Santi Maurizio Raineri 2,3, Sandro Tomasello 1† and Giuseppe Accurso 2*† 1Unit of Anesthesia, Intensive Care, and Hyperbaric Medicine, Civico Emergency Hospital, Partinico, Sicily, Italy, 2Department of Anaesthesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, Sicily, Italy, 3Department of Precision Medicine in Medical, Surgical and Critical Care, University of Palermo, Palermo, Sicily, Italy Background: Human metapneumovirus (hMPV) is an emerging respiratory pathogen causing illnesses from mild upper respiratory infection to severe pneumonia, particularly in high-risk adults. Although primarily recognized in pediatrics, hMPV is increasingly reported as a cause of acute respiratory failure in adults with chronic lung disease and obesity. Case: A 58-year-old man with morbid obesity and chronic obstructive pulmonary disease presented with acute respiratory failure and viral septic shock. Molecular testing of bronchoalveolar lavage (BioFire® FilmArray®) identified human metapneumovirus type 1 as the sole pathogen. The patient required invasive mechanical ventilation, vasopressor support, and continuous renal replacement therapy. Vancomycin was discontinued for suspected nephrotoxicity, and systemic corticosteroids were introduced. Subsequent bronchoalveolar lavage cultures grew Streptococcus pneumoniae, confirming bacterial superinfection. With supportive management, the patient gradually improved, was extubatedon day 9, and was discharged home in stable condition. Conclusion: hMPV can trigger severe respiratory failure and multiorgan dysfunction in adults with chronic respiratory comorbidities. Early molecular diagnosis is crucial to guide management and limit unnecessary antimicrobial exposure. The absence of specific antivirals underscores the need for continued research into targeted treatments and preventive vaccines. KEYWORDS human metapneumovirus, viral pneumonia, COPD, obesity, septic shock, case report Introduction Human metapneumovirus (hMPV) is an emerging respiratory pathogen that has gained increasing clinical relevance in adult intensive care. While most infections are self-limiting, hMPV can occasionally cause severe respiratory failure and viral sepsis in adults with chronic lung disease or obesity. This report describes a critically ill

FAQs

How was the cause of septic shock identified in this patient?

Molecular testing of bronchoalveolar lavage with BioFire FilmArray identified human metapneumovirus type 1 as the only pathogen responsible initially.

What major treatments were used during the critical phase?

The patient received invasive mechanical ventilation, vasopressor support, continuous renal replacement therapy, systemic corticosteroids, and supportive management.

What led to the diagnosis of bacterial superinfection?

Later bronchoalveolar lavage cultures grew Streptococcus pneumoniae, confirming bacterial superinfection after the viral diagnosis.

Sep 28, 2026

Uploaded by Rowan